From Patient to Prisoner: The Criminalisation of Mental Illness in Ireland. Dr Damien Brennan Lecturer, School of Nursing & Midwifery, Trinity College Dublin, Michael Brennan Lecturer, School of Nursing & Midwifery, Trinity College Dublin,

Overview of Paper Problem with “Historical Language” Problem with “Historical Language” Methodology Methodology Statistics Statistics Voices from the inside Voices from the inside

Residential ‘Service Provision’ in Ireland

Comparative Psychiatric Hospitalisation Rates

RankedCountry Number of Psychiatric Beds Per 100,000 of Population: WHO Annual Epidemiological and Vital Statistics Report for Ireland U.S.S.R United States Northern Ireland Scotland Sweden Barbados St Helena Hawaii Switzerland England and Wales Australia Malta and Gozo Belgium Bermuda Luxembourg Netherlands Antilles Norway Finland Jamaica238.82

Creation of a Tendency to Institutionalise Centralised Social Policy Planning for Asylums Expansion / Fragmentation of Local Demand, Payment and Control Dangerous Lunatic Acts 1838 & 1867 Fragmentation of Judicial / Medical Control over Admission Medical Takeover of Asylums / Establishing of Inspector of Asylums All Encapsulating Diagnostic Criteria 1843 Asylum Rules Family Participation in Asylum Admissions Poverty / Local Economic and Social Dependency on Asylums Closure of Institutions 2001 Mental Health Act UN Principles for the Protection of Persons with Mental Illness (1991) Renewed System of Inspection / Mandatory Legal Advocacy End of Local Economic Dependency on Asylums Celtic Tiger and Full Employment Emergence Mental Health Promotion Sale of Asylum Buildings Interruption of Tendency to Institutionalise of the ‘Mentally ill’ 1945 Mental Treatment Act – Consolidated Medical Control of Admissions Introduction of Psychopharmacology / ECT and Psychological Interventions International Standardisation of Classification Systems European Convention on Human Rights & Fundamental Freedoms (1950) Belated Deinstitutionalisation Social Policy (1966 & 1984) Increased Urbanisation/Industrialisation & Contestation of ‘Traditional’ Family

From Patient to Prisoner

Experiences ACCESS TREATMENT OUTCOMES INDIVIDUAL CIRCUMSTANCES Themes

STIGMA LACK OF INSIGHT STOPPED TAKING PRESCRIBED MEDICATON LANGUAGE LACK OF SERVICES DISTANCE FROM SERVICES Well as I said being from another country is a big problem… yeah stigma is big time here yeah. P8 The stigma and all that especially in the country… yeah yeah I was in a really rural area and everybody would know everybody else’s business and that. P4 The services don’t want to know you….once they hear that you were in prison or the Drum.’ P1 I won’t even get into a hostel now… now that I’m in for arson… they won’t let you in if you done that… so I don’t know…. At least prison can’t turn you away and they do look after you well P 9 I didn’t need to see anybody it was more a problem for me ma and the school you know.’ P15 ‘I think my language is a problem. I have communication problems there is nobody you can talk to in your own language’ P8 ‘I would stop taking my medication in the past because I’ d read up about them they cause you to put on weight and that and they would have a sedative effect I didn’t like that.’ P 11 ‘Looking back now I think I was discharged too soon and I didn’t have anyone to support me. You’re just left out to fend for yourself really.’ P12

Disengaged with services Disengaged with services ‘I would like to have a say into how and what treatment I get and for that matter if I even need treatment I don’t think that happens now nobody took on board my views yet so I don’t think they will start now. you are at there mercy they (psychiatrists) have the power’ P15 Loss of confidence Loss of confidence ‘Medication is just one thing it doesn’t solve the problem it’s a mix of things like as I say the activity.’ P1 ‘I can lead a decent life you know but I need to be given a chance just one chance to prove myself ….that’s all I want.’ P10 Homelessness Homelessness ‘I left home at about 17yrs…ended up going to hostels for young offenders…got in with the wrong crowd and eh I ended up in Pats (prison) and then I ended up in Mountjoy.’ P5 Involvement with Criminal Justice System ‘I was first in prison when I was 16 yrs I went into St Pats Institution I saw nobody in there about my behaviour or mental health and from then on I have been in and out of prison all the time. I spent very little time out you know just a few months between sentences. I would go home or sleep rough and ended up in trouble again.’ P15

From Patient to Prisoner: The Criminalisation of Mental Illness in Ireland. Dr Damien Brennan Lecturer, School of Nursing & Midwifery, Trinity College Dublin, Michael Brennan Lecturer, School of Nursing & Midwifery, Trinity College Dublin,